Current Issues in Aging: Campell

National Association of Area Agencies on Aging
Current Issues in Aging
2018 NADO Annual Training Conference, Charlotte, NC
Autumn Campbell, n4a
October 16, 2018

Consumer Publications

Agenda
• Fast Facts About the Aging Network
• Federal Budget and Funding for Aging Programs
• Older Americans Act Reauthorization
• Building the Bridge to Health Care
• A Look Into the Crystal Ball
• Questions?

Growing Needs/Growing
Numbers of Older Adults
2016 Top 5 Purpose of Call to the
Eldercare Locator
Purpose Percentage
Transportation 21%
Home and Community Based Services (HCBS) (In-Home Svcs
11%, Nutrition Svcs, 4%, Senior Center Programs 3%, LTC 2%, Case Management 1%,
Employment 1%) 20%
Housing 9%
Medical Services and Supplies (Medical Services 6% and Medical Supplies
and Equipment 3%) 9%
Health Insurance
6%

An Aging Network on the Move

Funding and Coordination of the Aging Network

All AAAs play a key role in:

Responding to the Needs:
AAA Trends and Directions
• Increasing Demand for Services with Limited Budgets
• Serving Broader Population
• Expansion of Health-related Services
• Expansion of Work in Integrated Care
• Increased Interest and Activity in Business Acumen and
Business Development to Meet Needs/Diversify $

Outreach
A core role of AAAs is to create local information and
referral/assistance (I&R/A) hotlines to help consumers find
aging and other HCBS programs.
With these resources and a portfolio of other outreach tools
including public education, staff and volunteers, ADRCs and SHIPs,
AAAs are able to assist clients match services and solutions to their
individual needs, enabling consumers to age in place with increased
health, safety and independence.

Nationwide Network with a
Local Flavor
• In 2017, there are 622 AAAs serving older adults in virtually
every community in the nation.
• In a few small or sparsely populated states, the state serves the
AAA function.
• The OAA is foundational for all AAAs, but because the law calls
for local control and decision-making, AAAs adapt to the unique
demands of their communities to provide innovative programs
that support the health and independence of older adults.

AAAs vary widely in size as
each state determines how
many service areas to
establish, which then
determines the number of
operating AAAs. For
example, Wisconsin has 3
AAAs, but New York has 59.

Aging Services Offered by AAAs
Percent
n=412
Legal assistance 92%
Respite care 89%
Benefits/health insurance counseling 85%
Transportation (non-medical) 85%
Case management 82%
Homemaker 74%
Personal assistance/personal care 74%
Options counseling 72%
Assessment for care planning 70%
Ombudsman services 70%

Aging Services Offered by AAAs
Percent
n=412
Enrollment assistance 64%
Home repair or modification 64%
Transportation (medical) 63%
Senior Center 61%
Emergency Response Systems 58%
Assessment for long-term care service eligibility 58%
Chore services 57%
Adult day service 55%
Evidence-based caregiver programs 51%

New Trends in the Aging Network

Broader Roles of AAAs

Tar Heel State Area Agencies on Aging

Tar Heel State Area Agencies on Aging
More Information at: https://www.n4a.org/2017aaasurvey

Federal Aging Policy Update

Aging Policy Challenges
• Lack of understanding, acceptance among lawmakers, public of
how huge this aging of the population is
• Room to move on crafting good aging policy!
– E.g., many states still not rebalanced, few truly livable
communities, treatment vs. wellness/prevention
• Uncertainty about long-term financial stability of key social
safety net and social insurance programs
• Short-term instability on annual federal budget (appropriations)

Federal Budget and Funding
for Aging Programs

OAA Federal Funding Status

Most of the Federal Budget = Defense, Social Security and
Major Health Programs
Chart Courtesy of Center on Budget and Policy Priorities

Federal Budget Snapshot
In FY 2017…
• Total Federal Spending = ~$4 Trillion
• Total Non-Defense Discretionary Spending =
$610 Billion (~15.25 percent)
• Total Older Americans Act Spending =
~$2 Billion
• Total OAA Spending as percentage of
Federal Budget = .05 percent

A Look Back:
Budget Battles, 2011-2018
• Recession, changes in politics drove louder conversation
about federal debt (and deficit)
• July 2011: Budget Control Act = caps, threat of
sequestration, Super Committee, debt ceiling relief
• March 2013: Sequestration
• October 2013: Shutdown
• Series of two-year budget deals (FY14-15/FY16-17), partially
offset sequester/caps
• Jan-Feb 2018: Two shutdowns
• February 2018: Third two-year budget deal (FY 18-19),
partially offset sequester/caps

Trump Administration Budget FY 2019
• Deep cuts to Non-Defense Discretionary (domestic)
programs (>40 percent/10 years) overall
• “Flat” funds most core Older Americans Act programs
• Cuts/eliminates critical domestic programs serving older
adults (SCSEP, SHIP, SSBG, CDBG, CSBG, LIHEAP, Housing,
Transportation)
• Guts Medicaid (states will limit HCBS)
• Repeals ACA (higher premiums, double uninsured rate
among pre-Medicare population)
• Nutrition assistance eliminated for 1 million seniors
• Cuts SSDI for 6 million people over 55

…BUT Congress Is Where the
Action Is
Theory:
– Budget resolutions passed by both chambers, agreed
to; sets high-level spending limits
– Appropriators develop 12 bills, move through
committee and to floor
– Everything done and signed by President by Sept. 30
Reality:
– After five CRs, two shut-downs and significant
compromises, final FY 2018 funding passed in March
2018 (nearly six months into FY)
– FY 2019—Return to “Regular Order”

Bipartisan Budget Agreement for
FY 2018-19 (February)
Highlights
– Rejected major cuts to domestic programs
President requested in FY 18-19
– Increased discretionary caps (for defense and
non-defense) by $300 billion over two years
– Included the CHRONIC Care Act (more on that
later!)
– Closed the Part D Donut Hole in 2019
– Included $80 billion in disaster relief funding
– 10-year reauthorization of CHIP
– Funding for opioid response

Older Americans Act BIG INCREASES!
• + $35 million for Title III B Supportive Services
• + $40 million for III C 1 Congregate Nutrition
• + $19 million for III C 2 Home-Delivered Meals
• + $5 million for III D Preventative Health
• + $30 million for III E National Family Caregiver Support
Program
• + $4 million for Title VI Native American
• +$1 million for Title VII Ombudsman
[HUD Section 202 +$105 million, Service Coords +$90 mil]
What Happened in FY 2018? (March)

Other Administration for Community Living
• State Health Insurance Programs preserved with
$2 million increase to $49 million
• Elder Justice (APS) Initiative, 20% boost to $12 million
• Aging and Disability Resource Centers boosted 32% to
$8 million
• CDSMP level at $8 million, Falls Prevention level at $5
million (Prevention and Public Health Fund)
• Lifespan Respite up 22% to $4.1 million
• Holocaust Survivors doubled to $5 million
FY 2018 Final Levels

Other Agencies, Proposed for Elimination
• OAA Title V Senior Community Services Employment
Program level funded at $400 million (Dept. of Labor)
• Social Services Block Grant, $1.7 billion
• Community Services Block Grant, $715 million
• Low-Income Home Energy Asst, boosted $240 million to
$3.6 billion
• Senior Corps, $202 million
• Community Development Block Grant, $3.24 billion, a
boost of $235 million
FY 2018 Final Levels

What About FY 2019?
Return to (roughly) Regular Order
• Labor-HHS Funding signed into law on Sept. 28
• Continuing Resolution (CR) for other agencies until
December 7
• $855 billion funding bill contains $178 billion for Labor-
HHS (including OAA/other Aging Programs)
• First time in 22 years!
• 9 of 12 bills passed in Senate; 7 of 12 bills passed in
House

What About FY 2019?
An FY 2018 Redux for OAA/Aging Programs
- Labor/HHS put with Defense bill
- Full-year funding!
- OAA programs mostly flat at FY 2018 levels
- Preserves 2018 increases
- $10 million increase for Title III C Nutrition Programs
- Make other small increases (OAA Title VI, RAISE, GRG,
Caregiver Corps)
- Avoids eliminations for key programs
- Increases funding for CSBG ($10 million) and LIHEAP ($50
million)

Older Americans Act Reauthorization
Lyndon Johnson signing the OAA, July 14, 1965.

Timeline of Major Amendments
1972 – Nutrition program
1978 – Home –delivered
meals authorized and
ombudsman services
required
1992 – Elder
rights recognized
1973 – AAAs created;
multipurpose senior centers
and community service
employment authorized
2006 – HCBS systems thru
ADRCs; evidence-based
health promotion services
2000 – National family
caregiver support program
1965
Present (Preparing for 2019
OAA Reauthorization)
2016 – Small changes to definitions,
specific authorization levels

Topics included:
Rising Demand
Eligibility
Flexibility
Transfer Authority
Targeting
Cost-Sharing
Data Collection
Private Pay
ADRCs

Older Americans Act Reauthorization
(current law expires Sept. 30, 2019)
n4a Process on OAA
• June-August: Preparatory phase—hearing
from the field; developing high-level
approach
• July-August: Comprehensive survey of n4a
members
• Currently: Review survey results, develop
initial priorities.
• November 6: Election will inform specific
advocacy strategy
• Early 2019: Release n4a OAA
reauthorization priorities to new Congress
and start advocating!
Coalition Process on OAA
• May-August: Leadership Council of Aging
Organizations (LCAO) reviewing 2011 coalition
priorities
• September-October: n4a taking a leading role
in negotiations to determine and elevate priorities
among the 72-member coalition
• November-January: Approve comprehensive
list of LCAO priorities and identify top few to
highlight for the Hill. Determine coalition
advocacy strategy.
• Early 2019: Release LCAO OAA reauthorization
priorities to new Congress and start advocating!

Building the Bridge to Health Care

Social Needs Affect Health
In a survey of 1,000 physicians:
 85% say unmet social needs directly leading to worse health
 85% say social needs as important to address as medical
conditions
 80% not confident in their ability to address social needs
Source: Robert Wood Johnson Foundation,
http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795

Medicare: New Opportunities Abound?
• Medicare largest federal
health care program
• Health happens at home: 80
percent of health care costs
are attributed to SDOH
• Traditionally, Medicare has
not touched these
factors

Medicare: New Opportunities Abound?
Emerging Opportunities for CBOs in Medicare
• CHRONIC Care Act (passed Feb. 2018)
• Medicare Advantage Call Letter for 2019
• Legislative proposals to add LTSS to Medicare
Challenges
• Not available for all beneficiaries
• Late notice for Medicare Advantage plans to implement
this year
• Cost

But What About Medicaid?
• 6 million low-income seniors and 10 million people with
disabilities receive services and supports through
Medicaid (=62% of Medicaid spending)
• Two-thirds of seniors in nursing homes rely on Medicaid
• 39% of American children are covered by Medicaid
(=21% of Medicaid spending)
• Overall, Medicaid covers nearly 80 million low-income
Americans
• 15% Medicaid spending covers non-disabled low-
income adults

AgingandDisabilityBusinessInstitute.org

Another Medicaid Issue: MFP
Money Follows the Person
• Medicaid rebalancing program, transitioned over 88k people from
institutional settings back to the community
• Bipartisan program with 12+ years of success; expired at the end of
FY 2016
• States running out of MFP money—ramping down programs; losing
infrastructure
• Bipartisan House/Senate bills to reauthorize: EMPOWER Care Act
(H.R. 5306 & S. 2227)
• House marked up its bill last month!
• See n4a.org/advocacy for what you can do to support MFP
reauthorization

Funding for OAA/Aging Programs
• FY 2019 stability for OAA/Aging programs
• Fights over budget caps will start again next year
Health Care Proposals
• Limited legislative traction due to election
• Administrative action will continue
• Potential: MFP
OAA Reauthorization
• Education is important through the end of the year
• Potentially high priority in early 2019—election will determine strategy
A Look Into the Crystal Ball

What Can Aging Advocates Do?

Key Advocacy Reminders
• Educate, educate, educate your elected officials
about the importance of OAA programs and delivering
aging services in the home and community!
• Build relationships with Members/staff
• Engage candidates in your work (site visits!)
• THANK your elected officials for advocacy wins
• Keep them informed about what is going on in your
community
• Engage with the media, too

Use n4a’s Advocacy Tools!

Questions?
Autumn Campbell, Director, Public Policy & Advocacy
acampbell@n4a.org

Current Issues in Aging: Campell

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